Infant Reflux
- Brittany Glass, MA, OTR/L, SWC, CLC
- Mar 25
- 4 min read
***Disclaimer! This article does not serve as medical advice, nor should it be treated as such. If you suspect that your child has reflux, you should consult your pediatrician and seek out additional support from certified health professionals trained in feeding, swallowing, allergy and GI dysfunction to guide treatment for your child's reflux. Attempting to diagnose and treat your child's reflux on your own may result in functional and/or medical problems going undiagnosed or untreated.
What is infant reflux?
Infant reflux happens when contents from the stomach (breastmilk, formula or bile) backflow up through the esophagus. As infants have an immature GI tract that is still developing while they take on a completely liquid diet very shortly after birth, a certain amount of reflux is completely normal for babies. However, when it becomes problematic, it can cause babies to spit up more than usual, feel uncomfortable during and after feeds, have abnormal bowel movements or blood in the stool, congestion during or after feeds, refusal to eat, and sometimes difficulties with weight gain.
Gastroesophageal reflux disease or GERD is a condition characterized by moderate to severe reflux symptoms that typically requires close monitoring, support and treatment. With that said, reflux in infants is often indicative of another functional or medical issue.
Reflux symptoms can be caused by:
Too much air being taken in during breast or bottle-feeding
Weak lower esophageal sphincter
Oversupply and overeating
Allergy or intolerance to something in the mother’s breastmilk or formula
Excessive time in a flat supine position
Other GI issues that require assessment by medical professionals specializing in gastrointestinal disorders and dysfunction
What could cause my baby to take in excess air during feeding?
Positioning
Pacing
Shallow latch
Flow mismanagement
Oversupply
Tongue-tie
Other anatomical/structural anomalies
How do I know if my baby has an allergy to something in my breastmilk or formula?
The most common way of assessing whether a baby is reacting to something in the milk they are getting is by your testing the baby's stool followed by your health care provider helping you begin an elimination diet or switching to a formula without common allergens (dairy, wheat, soy) if/when blood is detected in the stool.
Cow's milk protein allergies in young infants is fairly common and often the first recommended item to be eliminated. As infants present with an immature gut, some experience irritation of the stomach in response to dairy when they are younger and many grow out of it and are able to tolerate dairy without any difficulties later on.
Other common allergens that can be passed through breastmilk:
Soy
Eggs
Wheat
How can oversupply impact reflux?
If you have an oversupply and quick letdown, your baby may have difficulty managing the flow and you may see them gulping or struggling to keep up with the fast flow when you breastfeed. When a baby has difficulty with managing a fast flow in this manner, they tend to take in more air. Additionally, babies of breastfeeding moms with an oversupply have a tendency to overeat, placing further pressure and irritating the stomach. The good news........just like allergy or other issues causing reflux, oversupply can be managed with support to help reduce overeating and air intake during feeding.
How can tongue tie impact reflux?
A baby's tongue has probably the singular most important role to play in a baby's ability to continuously create a negative pressure suction system to pull milk successfully from the breast or bottle, transfer milk from the breast or bottle and complete repeated safe swallowing. If a baby has a tongue tie, it can impact their ability to create and maintain a seal around the nipple to pull, transfer and swallow milk efficiently. When the tongue struggles to maintain that seal either during sucking or swallowing, the baby may take in a lot more air than they should, thus contributing to reflux symptoms.
The challenge with treating reflux:
If your baby is experiencing reflux symptoms, then you may know the struggles of feeding and trying to keep your baby comfortable all too well. One of the biggest challenges with treating reflux is that there is no finite test to diagnose it, only symptoms to go by. Sometimes a baby may spit up, but seems comfortable. Other times a baby does not spit up at all, but is very uncomfortable during or after feeds.
Your baby may be prescribed medication to reduce discomfort and while this can often be helpful in taking the edge off, you may still find that your infant rejects opportunities to eat, doesn't eat an apporiate amount, has very prolonged feeding sessions with multiple pauses and breaks, has slow weight gain, or is continuing to present with excessive spit up. This is where it can be helpful to seek out support with evaluating and addressing underlying issues. When dealing with infant reflux, working with collaborative providers specialized in assessing all of the aforementioned areas and treating symptoms accordingly is key to helping you and your baby find relief and joy in nursing or bottle feeding.
If your infant is presenting with one or more reflux symptom, reach out to your local provider trained in assessing and treating infant feeding and swallowing challenges.
